Ration End-Of-Life Care

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Wednesday, October 10, 2012 


Just because we can extend life, should we? The U.S. is expected to spend $2.8 trillion on health care in 2012. Medicare alone will cost taxpayers $590 billion, with over 25% going toward patients in their last year of life. If health care is a scarce resource, limited by its availability and our ability to pay for it, should government step in to ration care, deciding whose life is worth saving? In other words, how much is an extra month of life worth? 


  • Art-Kellermann-web


    Dr. Art Kellermann

    Chair in Policy Analysis, RAND Health

  • petersinger web


    Peter Singer

    Ira W. DeCamp Professor of Bioethics, Princeton University

  • sallypipes web


    Sally Pipes

    President and Chief Executive Officer, Pacific Research Institute

  • kenconnor web


    Ken Connor

    Chairman, Center for a Just Society

    • Moderator Image


      John Donvan

      Author & Correspondent for ABC News

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For The Motion

Dr. Art Kellermann

Chair in Policy Analysis, RAND Health

Arthur Kellermann holds the Paul O'Neill Alcoa Chair in Policy Analysis at the RAND Corporation. Before joining RAND, he was a Professor of Emergency Medicine and Public Health and Associate Dean for health policy at the Emory School of Medicine in Atlanta. Kellermann founded Emory's Department of Emergency Medicine and served as its first chair from 1999 to 2007. As a Robert Wood Johnson Health Policy Fellow, Kellermann worked for the professional staff of the Committee on Oversight and Government Reform, U.S. House of Representatives. A clinician and researcher, he practiced and taught emergency medicine for more than 25 years.

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petersinger web

For The Motion

Peter Singer

Ira W. DeCamp Professor of Bioethics, Princeton University

Peter Singer is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University. He specializes in applied ethics and approaches ethical issues from a secular, preference utilitarian perspective. Singer is well-known for his book, Animal Liberation, a canonical text in animal rights/liberation theory. From 2005 on, Singer has also held the part-time position of Laureate Professor at the University of Melbourne, in the Centre for Applied Philosophy and Public Ethics.

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sallypipes web

Against The Motion

Sally Pipes

President and Chief Executive Officer, Pacific Research Institute

Sally Pipes is President and Chief Executive Officer of the Pacific Research Institute (PRI), a San Francisco-based think tank founded in 1979.  In November 2010, she was named the Taube Fellow in Health Care Studies.  Prior to becoming President of PRI in 1991, she was Assistant Director of the Fraser Institute, based in Vancouver, Canada. Pipes' latest book, The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare, is a follow-up on her book The Truth About Obamacare (2010). She writes a weekly health care column called “Piping Up” for Forbes.com.

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kenconnor web

Against The Motion

Ken Connor

Chairman, Center for a Just Society

In 2005, Ken Connor founded the Center for a Just Society, where he serves as the organization’s Chairman. Connor is affiliated with the law firm of Connor & Connor, LLC, a firm nationally known for its successful representation of victims of nursing home abuse and neglect.  He served as Counsel to Governor Jeb Bush in Bush v. Schiavo, one of the country’s most watched cases in the long-running legal battle to protect a severely disabled woman, Terri Schindler Schiavo, from a court order to remove her feeding tube. Because of his advocacy on behalf of nursing home residents, the state’s Democratic Attorney General appointed him to Florida’s Task Force on the Availability and Affordability of Long Term Care.

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Declared Winner: For The Motion

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About This Event


  • Comment Link Jan Thursday, 02 July 2015 16:24 posted by Jan

    Actually when someone doesn't understand then its up to other people
    that they will assist, so here it occurs.

  • Comment Link Taylar Thomas Sunday, 30 November 2014 13:51 posted by Taylar Thomas

    I really enjoyed this debate. After, hearing each side, I have to say that Dr. Kellerman, really gave it his all and swayed me toward their way with my vote.

  • Comment Link JOAQUIN TANKSLEY Tuesday, 14 October 2014 21:01 posted by JOAQUIN TANKSLEY

    I was surprised at how the debate for half/half…. It was some that believed healthcare should be rationed and some who believed it was wrong. This kinda of gave me a stronger stance and i Enjoyed my statement about rationing of care

  • Comment Link Starion Cuka Monday, 13 October 2014 23:16 posted by Starion Cuka

    The debate was not over what panel is going to chose who lives and who dies but rather where to ration healthcare costs in places that it is not needed. Most importantly the informed decision to define the meaning of "this treatment does not make sense" or "the risks outweigh the benefits" the care for a patient and rationing is not decided only on a financial basis but also on other decisive criteria such as the disease that the patient is suffering from. You have to believe on a higher understanding of rationing care. Nobody is going to ration chronic disease management for example instead more is going to be invested in patient education. At the same time a cost vs. effect analysis is going to determine which services are excessive at an end of life stage of care.
    Remember that the formula works on both ends. By investing in early management and broader coverage, you are reducing the emergent end of life care situations. For example one has to decide between ordering extra treatments for their terminal wife and selling their firstborn or agreeing with the medical fact that even if she lived, she would live to agonize over the choices that you have made for her. and die of the side effects of the economically and medically unjustified extra treatment.
    Like the speakers on both sides said - this is not black and white. There is other colors involved such as private insurance and funding. My vote is cast to PRO.

  • Comment Link Tony Saturday, 09 August 2014 13:07 posted by Tony


    It is impossible to remove the government from personal life or death decisions.

    We have two possibilities, either we pay for the health care ourselves or we get other people to help pay for it.

    Pay for it ourselves: The amount you have to spend on your health care will be affected by how much you have to pay in taxes prior to needing care, and therefore it will affect your decision making process.

    Other people help pay for it: People will never exist solely on private insurance, therefore the government is going to be directly responsible for, and have to make decisions on how much money can be spent for health care. They don't have unlimited funds, only the amount of funds they get from taxes plus the amount they can borrow.

    So rather than try to make a play for removing the government from these decisions, since it is impossible, the better alternative is to provide a means to limit the government's influence.

  • Comment Link MM Friday, 21 February 2014 09:01 posted by MM

    This definitely a slippery slope when we involve government into personal life or death decisions

  • Comment Link Baruch Sunday, 03 February 2013 18:09 posted by Baruch

    This was a really disappointing semi-debate. Only Dr. Kellerman made sense, perhaps because he was a physician. He spoke to the point and dealt with the issue. Ms. Pipes spoke to a completely different topic, one with which we can empathize, but which had nothing to do with end-of-life care. The lawyer needs help. Prof Singer did not do well.
    But there is such a thing as painful, wasteful, futile prolongation of life. Dr. Kellerman put it well: when there is no chance for improvement or cure, offer compassionate care.
    Do not ration treatment on the basis of cost but on the basis of medical value.
    Try not to focus on the aged; end-life-care applies to neonates, children, adolescents, adults and the old.
    The same principles apply regardless of age.

  • Comment Link James Sunday, 06 January 2013 19:59 posted by James

    I really enjoyed listening to Dr. Kellermann debate this issue. I'm looking forward to seeing how the Obama admin continues to dissuade healthcare professionals and for-profit hospitals from committing fraud. I was hoping for more discussions on hospices in this debate, but maybe next time.

  • Comment Link chris Saturday, 05 January 2013 17:21 posted by chris

    I don't know if we should or should not ration end of life care. What I do know is that we shouldn't start expensive unnecessary wars, or try to reform the rest of the world, but instead think about our own citizens for a change.

  • Comment Link Kenda Friday, 04 January 2013 21:07 posted by Kenda

    This was the first Intelligence Squared Debate I ever heard, and it was excellent, civil and well structured. But the balance of the sides was uneven, with the better debaters and stronger arguments on the "for" side. I agree with some of the other postings, that the panel against the motion was much weaker than the panel for it. In particular, Connor was stolid and unsubstantiated, full of hollowed-out buzzwords and hot wind.

  • Comment Link Max Friday, 04 January 2013 17:00 posted by Max

    Liberals voted for obamacare not realizing that they too would get old and the same death panels would decide their fate. Ignorance has high consequences and liberals voted for it. They voted for empty promises and that is just what they will get, lots of emptiness....

  • Comment Link Manix Friday, 04 January 2013 12:55 posted by Manix

    Good debate. Any legislation implemented should encourage the responsible parties to advocate for realistic decisions about the life of their loved ones, while in the hospital bed. Kellermann has a strong, humane argument that facilitates realistic and sensitive decision-making regarding under what conditions a person's life should be extended: communication and objective medical information at the most basic level, between relatives, patient, and physicians. Laws must facilitate this process, while ensuring that a 20 y/o person will not die because resources were not properly allocated. We all want to keep our loved ones with us "a little longer". But the right decision, at that very moment, may not necessarily be what we want. It is at this moment when something or someone needs to step in and help us understand that it's time to let go. We also need to hold the government accountable in reducing wasteful spending, not just in the healthcare system, but across the board. Let us remember that, as someone else said, "you can have all the money in the world and the best technology is not going to keep you alive when your day has come".

  • Comment Link Stephen Malinowski Thursday, 03 January 2013 00:19 posted by Stephen Malinowski

    I don't see how end-of-life care --- or *any* kind of health care, for that matter --- can help but be rationed. Any time you need health care, there is the opportunity to spend arbitrarily more money --- more tests, more doctors' opinions, more drugs, more therapy. We're *always* rationing, always drawing the line somewhere, and saying "that's enough --- more than this just isn't worth the money (or the effort)." The question is how this rationing is to be done. Should we let a young person without health insurance die because they don't have the money for a life-saving treatment? Should we spend thousands of dollars a day to keep a patient with advanced Alzheimer's alive? If we only have enough money to pay for one or the other, which should it be? These are the kinds of questions we need to be addressing; the question of whether we must ration is moot.

  • Comment Link Dan Sunday, 11 November 2012 21:37 posted by Dan

    Just heard a re-broadcast of the debate. How could they NOT have a doctor on the against side? Although, I think that the arguments of Kellermann and Singer were sharper, I actually agreed with Ken Connor when he said during his closing argument: This does not have to be a case of one or the other. I believe this to be true.

    As Americans, we should be willing to pay a large amount for health care - period -- so this means NO to rationing for the elderly as well as making sure everyone is insured. Does this mean an amazingly expensive Star Trekian health care system? You bet, but that's what we should want. Thus, we should focus our time on reducing costs in other areas of our lives. Besides finding ways to reduce waste in the health care industry, energy, could be a lot cheaper if we really wanted it to be. Also, we have become a more materialistic society wasting our money on many gadgets we don't need. Maybe it's time to set our priorities a little differently -- we can't have it all, but we when it comes to our health, we should want no less.

  • Comment Link Terri Thursday, 08 November 2012 14:27 posted by Terri

    As an ER nurse I could not agree more with this motion . We intubated 97 yo people with sepsis and send them to the ICU , I ran across a 98yo guy who was getting chemo for lung cancer and don't for one minute think your advanced directive means anything - I recently took care of a woman who had a dnr/dni on file - she was gravely ill and would have died but even though she had the directive in place , when asked , her husband asked that she be intubated , which she was and then admitted to the ICU , only to die a day or two later but not before racking up 10's of thousands of dollars in - yes- wasted care and resources . It really is a travesty .

  • Comment Link Paul G Thursday, 08 November 2012 00:49 posted by Paul G

    This debate was, for me, a microcosm of the 2012 presidential election.

    In one corner (for the motion), was a side I don't particularly agree with philosophically. But the individuals were well spoken, thoughtful, and frankly sounded like they knew what they were talking about.

    In the other corner (against the motion), was a side I initially felt very good about. But the debaters were wretched. Their logic was flawed, their attacks were ad hominem, and they generally made no sense. Ms. Pipes essentially took the position that all people should have access to all procedures at all times, which certainly sounds nice... unless one considers the fiscal implications of her proposal.
    Both of these debaters against the motion were so unpalatable, I found myself thinking, "if they're against the motion, I think I'm for it."

    What happened to the intelligent conservatives?

  • Comment Link GEDouglas Wednesday, 07 November 2012 04:37 posted by GEDouglas

    So, we start by classifying the old as not worth the expense, then the IPAP decides that a mentally retarded person does not warrant the expense, then a person with certain physical disabilities or deformities are deemed unworthy. Where does it end? I believe history shows us where this disregard for life mentality leads. Recent history...say 1937-45 under the the National Socialist regime.

  • Comment Link Mike Friday, 02 November 2012 23:33 posted by Mike

    I call bs on Mrs. Pipes stories about Canada. I'm Canadian and I've never heard of any of the problems Mrs. Pipes complains about. I've had several family members who've had to deal with the medical establishment and most are more than happy with the outcome. I would suggests that her story is an exception, not the average

  • Comment Link Paula Lee Sunday, 28 October 2012 11:00 posted by Paula Lee

    I was for the motion before and after the debate. I don't mean to disrespect the against panelist, but I believe that they were not at the level of the other side. The quality of their oratory was sub-par, Intelligence square needs to bring better representatives for the conservative side. Kellerman and Singer tried to engage them, but Pipes and Connor were arguing from a very emotional place.
    The only concern I have for rationing is the possibility that it stifles innovation. For example, a lot of the safety technology we have in cars were first developed in luxery cars, which later trickled down to all of us, could the same dynamic be applied to healthcare?

  • Comment Link Greg Monday, 22 October 2012 11:52 posted by Greg

    The results of this debate were extremely disturbing. I don't want insurance companies or the government making these kinds of decisions.

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